“Some of these people just lost their insurance. Some of them work, but don't make very much. Some of them are self-employed,” said Copeland, a feisty 85-year-old who's been running Pottawatomie County's free clinic since it opened 14 years ago.

“You can usually tell by looking at them that most of them really need the help.”

Copeland is in charge of recruiting doctors, nurses, pharmacists and other helpers who donate their time on Thursday evenings to help Pottawatomie County residents who don't have health insurance and don't qualify for government aid.

Coincidentally, she's also the aunt of Gov. Mary Fallin, who grew up in Tecumseh as Mary Copeland. In November, Fallin rejected an Obama administration offer to finance much of the cost of expanding Oklahoma's Medicaid program.

If Fallin had accepted, many of the people filing into the clinic this evening would be eligible to participate.

Pottawatomie County's free clinic is a microcosm of the health coverage challenge facing Oklahoma policymakers. Fallin's decision to reject the Medicaid expansion has left an estimated 130,000 or more low-income Oklahomans in a coverage crater that offers few options for affordable health care.

The problem tends to be more pronounced in smaller towns and rural areas, where incomes often are lower and employers less likely to offer benefits.

Asked to comment on the clinic operation, Fallin praised the work that Copeland and others are doing, describing her aunt as “a wonderful lady who has spent much of her career dedicated to helping other Oklahomans.”

The governor said she is looking for ways to address the coverage crater, but remains convinced that the Obama initiative is “unaffordable and unworkable.” Even with the federal government picking up much of the tab, Fallin's office contends the expansion would increase state spending by $689 million over 10 years.

Advocates of expansion counter that the cost to the state would be minimal.

Fallin said she would propose a “substantial increase” in health funding when the Legislature convenes in February. State health officials, meanwhile, have hired a Utah consultant to make recommendations for possible legislative action this year.

For several thousand uninsured people in Pottawatomie County, Copeland's free clinic is still the best thing going.

‘Trying to survive'

Standing at the head of the line in the clinic tonight is Brad Trice, 45. He's divorced and lives with his father in Tecumseh.

Trice said he has been coming to the clinic for free prescriptions since his blood pressure skyrocketed to 250/170 several months ago, landing him in the hospital emergency room.

Trice said he hasn't worked since 2010, when he lost his job as a certified nursing assistant at a Seminole nursing home. He hasn't had health insurance since 2005, when he was working at a Walmart store.

“I'm just a human being trying to survive,” he said. “But we're all doing that.”

On a previous visit, Trice asked the clinic for help with a badly ingrown toenail. He was referred to an outside physician, who wanted $250 to fix it. The clinic doesn't offer surgical services.

Trice said he couldn't afford to pay that much. “It still hurts like a son of a gun,” he said.

Expansion plan

About 28 percent of Pottawatomie County residents between the ages of 18 and 64 had no health insurance in 2011, according to the U.S. Census Bureau. That compared to 26 percent statewide.

Many of them would be eligible for government-paid health care under the Obama initiative, which would have expanded Oklahoma's Medicaid program to all working-age adults with incomes up to 133 percent of the poverty level.

That equates to $14,856 a year for a couple and $30,656 for a family of four.

Under existing law, Oklahoma's Medicaid program excludes adults unless they have dependent children living at home and their income falls below a relatively low level — $4,368 for two people and $6,996 for a family of four.

Pottawatomie County is not as poor as some places in Oklahoma, but it fares worse than the state as a whole in most key economic indicators. Eighteen percent of the population falls below the poverty level.

Fallin grew up in Tecumseh, a community of 6,443 just south of the county seat, Shawnee. Both her father and mother were mayors of Tecumseh, and Fallin attended Oklahoma Baptist University in Shawnee before graduating from Oklahoma State University.

In a 2011 interview with the Tecumseh Countywide newspaper, Fallin said her original career goal was to be a social worker. She said she was inspired by her mother, who worked as a district supervisor for the Oklahoma Department of Human Services.

‘I need a job'

Marking time about halfway down the hallway are Jason and Linda Popielarski, of Tecumseh. They are here to see a doctor about Linda's sinus infection and to get her blood pressure prescription refilled.